Introduction
Patients and methods
Patients
Type of treatment | Patients operated | Patients at follow-up | Follow-up in years | Age at treatment | Dominant hand affected | Employment status | Occupational group | ||||
---|---|---|---|---|---|---|---|---|---|---|---|
Full-time worka
| Unemployedb
| Blue collar | White collar | ||||||||
Total | Total | Mean | SD | Mean | No. (%) | No. (%) | No. (%) | No. (%) | No. (%) | ||
STT | 46 | 27 | 4 | 2.99 | 37 | 19 (70) | 25 (93) | 2 (7) | 12 (44) | 13 (48) | |
RSO | 21 | 14 | 10 | 7.43 | 34 | 9 (64) | 12 (86) | 2 (14) | 4 (29) | 8 (57) | |
VBGc
| 7 | 4 | 1 | 0.7 | 38 | 1 (75) | 4 (100) | 0 | 2 (50) | 2 (50) | |
VBGd and RSO | 3 | 2 | 4 | 1.06 | 29 | 1 (50) | 2 (100) | 0 | 2 (100) | 0 | |
Differences | |||||||||||
STT vs. RSO |
p
| <0.01e
| 0.87e
| 0.69f
| 0.54f
| 0.49f
| 0.28f
| 0.59f
|
Medical record evaluation
Self-assessment questionnaire
Interview and clinical examination
Radiological assessment
Statistical analysis
Pre-E/F | Post-E/F | Pre-R/U | Post-R/U | Pre-P/S | Post-P/S | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Mean | SD | Mean | SD | Mean | SD | Mean | SD | Mean | SD | Mean | SD | |
STT (n = 27) | 91° | 4.5 | 83° | 16.4 | 42° | 11.6 | 33° | 9.9 | 167° | 13.5 | 155° | 20.2 |
RSO (n = 14) | 73° | 8.0 | 93° | 42.5 | 37° | 10.1 | 43° | 19.8 | 166° | 10.4 | 149° | 17.2 |
VBG (n = 4) | 96° | 12.5 | 70° | 55.7 | 51° | 26.6 | 30° | 27.8 | 165° | 19.1 | 150° | 0 |
RSO and VBG (n = 2) | 115° | 15.0 | 95° | 7.1 | 55° | 7.1 | 48° | 10.6 | 170° | 14.1 | 145° | 7.1 |
Post-treatment differences | ||||||||||||
RSO vs. STT (P value) | 0.38a
| 0.09a
| 0.48a
| |||||||||
Estimated clinically relevant difference | 30°b
| 20°b
| 20° | |||||||||
Sample size calculation | 66 | 34 | 36 |
NRS at rest | Grip strength dominanta
| Grip strength non-dominantb
| DASH | Time to return to work in weeks | No. of complicationsc
| MMWS | Same operationd
| |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Median | SD | Mean (%) | SD | Mean (%) | SD | Mean | SD | Mean | SD |
n (%) | Mean | SD |
n (%) | |
STT (n = 27) | 1 | 2 | 85 | 23 | 79 | 14 | 44 | 19 | 4 | 1 | 12 (44) | 70 | 7 | 24 (89) |
RSO (n = 14) | 1 | 1 | 87 | 17 | 66 | 9 | 43 | 19 | 4 | 1 | 3 (21) | 71 | 9 | 14 (100) |
VBG (n = 4) | 0 | – | 99 | 5 | 105 | – | 47 | 28 | 2 | 1 | 1 (25) | 78 | 10 | 4 (100) |
RSO and VBG (n = 2) | 3 | – | 6 | – | 78 | – | 54 | 11 | 4 | 1 | 0 | 75 | 14 | 0 |
Post-treatment differences | ||||||||||||||
STT vs. RSO (P value) | 0.88e
| 0.86f
| 0.19f
| 0.59f
| 0.93f
| 0.19e
| 0.93f
| 0.20e
| ||||||
Estimated clinically relevant difference | 2.5g
| 20 | 20 | 20h
| 2 | 20 | 20 | |||||||
Sample size calculation | 24 | 44 | 18 | 32 | 12 | 192 | 10 |
Pre-Ståhl index | Post-Ståhl index | Pre-Nattrass index | Post-Nattrass index | Pre-radius-scaphoid-angle | Post-radius-scaphoid-angle | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Median | SD | Median | SD | Median | SD | Median | SD | Median | SD | Median | SD | |
STT (n = 27) | 0.37 | 0.07 | 0.32 | 0.08 | 0.70 | 0.06 | 0.69 | 0.04 | 59° | 6.11 | 51° | 5.35 |
RSO (n = 14) | 0.37 | 0.1 | 0.32 | 0.11 | 0.70 | 0.06 | 0.71 | 0.08 | 56° | 7.71 | 63° | 5.58 |
VBG (n = 4) | 0.48 | 0.1 | 0.44 | 0.09 | 0.69 | 0.01 | 0.69 | 0.01 | 62° | 7.48 | 64° | 8.49 |
RSO and VBG (n = 2) | 0.39 | 0.04 | 0.30 | 0.07 | 0.72 | 0.04 | 0.74 | 0.05 | 46° | 5.66 | 60° | 8.49 |
Pre- to post-treatment differences | ||||||||||||
RSO (P value) | 0.21a
| 0.67a
| 0.13a
| |||||||||
VBG (P value) | 1.00a
| 0.32a
| 0.06a
| |||||||||
RSO and VBG (P value) | 0.18a
| 0.18a
| 0.18a
| |||||||||
Estimated clinically relevant difference | 0.1 | 0.1 | 8° | |||||||||
Sample size calculation | 42 | 24 | 38 |
Results
Clinical outcomes of STT compared to RSO
Radiological outcomes of RSO or VBG and of RSO and VBG
Discussion
Strengths and weaknesses of the study
Clinical outcomes
Author | Data assessment | Treatment (inclusion rate of wrists with KDd) | Follow-up in years (SD) | Post-op pain | Post-op DASH without work module | Post-op E/F | Incapacity for work (weeks) | Significant difference in clinical outcome |
---|---|---|---|---|---|---|---|---|
Afshar, 2013 [42] | Chart review | RSO (9/9) | 6.4 ± 1.8 | NM | NM | NM | NM | None |
Examination | VBG (7/7) | 6.5 ± 1.6 | NM | NM | NM | NM | ||
Martin, 2013 [43] | DASH only | Conservative (44/44) | NM | NM | 23.7 ± 24.5 | NM | NM | None |
Partial wrist fusion (11/11) | NM | NM | 20.0 ± 20.1 | NM | NM | |||
Complete wrist fusion (5/5) | ||||||||
Lunate excision (1/1) | ||||||||
RSO (1/1) | ||||||||
Hohendorff, 2012 [44] | Chart review | STT (8/8) | 1 | VAS at restb, 28 ± 31 | 21 ± 16 | 56° ± 16 | NM | Better E/F and R/U after PRC |
VAS activity-inducedb, 30 ± 27 | ||||||||
Examination | PRC (11/11) | 1 | VAS at restb, 16 ± 29 | 19 ± 20 | 80° ± 23 | NM | ||
VAS activity-inducedb, 30 ± 26 | ||||||||
Van den Dungen, 2006 [45] | Chart review | Conservative (19/59) | 12 | Pain quality and duration | 21 | 92° | 2.6 | Less pain, better ROM, faster return to work after conservative treatment |
Examination | STT (11/25) | 14 | Pain quality and duration | 17 | 74° | 17.1 | ||
Das Gupta, 2003 [46] | Examination | STT (13/13) | 1.9 | NM | 19 | 68° | NM | NM |
RSO (20/42) | 6.9 | NM | 14 | 106° | NM | |||
Salmon, 2000 | Chart review | Conservative (15/18) | NM | NRS at restb, 2.8 | NM | NM | NM | NM |
NRS at worstb, 3 | ||||||||
Examination | RSO (14/15) | NM | NRS at restb, 0.5 | NM | NM | NM | ||
NRS at worstb, 7.6 | ||||||||
Nakamura, 1998 [48] | Chart review | PRC (7/7) | 6.7 | Pain yes/no | NM | 64° | NM | None |
STT (7/7) | 3.5 | Pain yes/no | NM | 76° | NM | |||
SC (4/4) | ||||||||
RL (3/3) | ||||||||
LC (1/1) | ||||||||
Delaere, 1998 [49] | Chart review | Conservative (22/22) | 5.4 | Pain quality and duration | NM | 97° | NM | Better ROM after conservative treatment |
Examination | STT (11/11) | 5.5 | Pain quality and duration | NM | 68° | NM | ||
PRC (6/6) | ||||||||
Vessel implantation (3/3) | ||||||||
RSO (1/1) | ||||||||
Ulnar lengthening (1/1) | ||||||||
Denervation (1/1) | ||||||||
Condit, 1993 [50] | Chart review | RSO (14/15) | 5.2 | NM | – | NM | NM | Better clinical outcome after RSO according to own wrist scoring system |
Examination | STT (9/9) | 4.5 | NM | – | NM | NM | ||
Kristensen, 1986 [51] | Chart review | Immobilization (23/23) | 23 | VRSa (0–3), 2 ± 0.7 | – | NM | NM | NM |
Examination | No specific treatment (24/24) | 18.2 | VRSa (0–3), 2 ± 0.7 | – | NM | NM | ||
Evans, 1986 [52] | Chart review | Conservative (14/14) | 1.8 | VRSa (0–3), 1 ± 0.7 | – | 68° | NM | NM |
Examination | Silastic arthroplasty (21/21) | 3.2 | VRSa (0–3), 1 ± 0.8 | – | 69° | NM | ||
Beckenbaugh, 1980 [53] | Chart review | Conservative (7/10) | 7 | No patient had pain | – | 89° | NM | None |
Examination | Silastic arthroplasty (22/22) | 3.8 | No patient had pain | – | 75° | NM | ||
Stahl, 2015 [54] | Chart review | STT (27/46) | 4b ± 3c
| NRS at rest, 0a ±2 c
| 44.3b ± 19c
| 83°b ± 16c
| 4b ± 3c
| None |
NRS activity-induced, 5a ±2c
| ||||||||
Questionnaire | RSO (14/21) | 10b ± 7.4c
| NRS at rest, 1a ± 1c
| 43.9b ± 19c
| 93°b ± 42c
| 5b ± 3c
| ||
Examination | NRS activity-induced, 6a ±2 c
|
Radiological outcomes
Treatment (inclusion rate of wrists with KD) | Follow-up in years (min, max) | Δ Ståhl index | Δ Carpal height index | Δ Radioscaphoid angle | Significant difference in radiological outcome of comparative studies | |
---|---|---|---|---|---|---|
Matsui, 2014 [55] | RSO (11/11) | 14.3 | +0.01 | 0 | NM | – |
Fujiwara, 2013 [56] | VBG'd' alone or combined with capitate shortening or RSO (8/8) | NM | +0.03b
| +0.028b
| NM | NM |
VBG (10/10) | NM | −0.004 | +0.004 | NM | ||
Watanabe, 2008 [57] | RSO (13) | 21 | −0.03b
| −0.01b
| −3° | – |
Wada, 2002 [58] | RSO (13) | 14 | −0.06b
| −0.03b
| NM | – |
Iwasaki, 2002 [59] | Closing wedge osteotomy (11) | 2.25 | −0.06 | −0.03 | +5.6°b
| No |
RSO (9) | 2.6 | 0 | +0.01 | −1.1 | ||
Moran, 2002 [60] | VBG (26) | 2.6 | 0.02c
| 0.008c
| NM | – |
Wintman, 2001 [61] | RSO (72/88) | 2.6 ± 2.2 | NM | +0.01b
| NM | – |
Salmon, 2000 [47] | Conservative (15/18) | NM | Δ carpal height, −0.7 mm | NM | +5.4° | NM |
Δ lunate width, +2.0 mm | ||||||
RSO (14/15) | NM | Δ carpal height, −0.7 mm | NM | +2.1° | ||
Δ lunate width, +2.4 mm | ||||||
Stahl, 2015 [54] | RSO (14/21) | 10.5 ± 7.4 | −0.03 | −0.01a
| +7° | No |
VBG (4/7) | 1.2 ± 0.7 | −0.04 | 0a
| +2° | ||
VBG and RSO (2/3) | 3.9 ± 1.1 | −0.09 | +0.02a
| +14° |